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Difficulty: HardInitial Premium and Premium Receipts

Arthur applies for a life insurance policy and pays the first premium, receiving a conditional insurability receipt. The insurer requires a medical examination. Arrange the following events in the strict chronological sequence required to illustrate how his coverage becomes retroactively effective, culminating in a paid claim after an unexpected tragedy.

  1. 1Arthur submits the application, pays the initial premium, and receives a conditional insurability receipt.
  2. 2Arthur completes the insurer's mandatory medical examination.
  3. 3Arthur dies in a sudden accident before the home office has issued the physical policy.
  4. 4The underwriting department conducts a post-mortem review of Arthur's application and medical exam results.
  5. 5The underwriter determines Arthur was insurable as a standard risk as of the date of his medical exam.
  6. 6The insurer honors the conditional receipt and pays the full death benefit to Arthur's beneficiary.

Answer

The correct sequence is: Application and premium submission, followed by the medical exam, followed by the accidental death, followed by the post-mortem underwriting review, followed by the determination of standard insurability, and finally the claim payment.
The correct sequence illustrates the strict legal mechanism of a conditional insurability receipt when a medical exam is required. Coverage cannot begin until the medical exam is completed. If the applicant dies after the exam but before policy issuance, the insurer must conduct a post-mortem underwriting review. Only if the underwriter determines the applicant was insurable as a standard risk as of the exam date will the coverage be deemed retroactively effective, obligating the insurer to pay the death benefit.

Step-by-Step Solution

1
Identify the type of receipt issued.
A conditional insurability receipt was issued.
This determines when the coverage can become effective.
2
Determine the required conditions for coverage to begin under this receipt.
The applicant must complete the required medical exam and be found insurable as a standard or better risk.
Under a conditional receipt with a required medical exam, the potential effective date is tied to the date of the exam, not the application date.
3
Evaluate the timeline of the applicant's death.
The applicant died after completing the medical exam but before the policy was issued.
Because the exam was completed prior to death, the insurer can proceed with a post-mortem underwriting review to evaluate insurability as of the exam date.
4
Determine the outcome of the underwriter's post-mortem review.
The underwriter confirmed the applicant was a standard risk as of the exam date.
This fulfills the primary condition of the receipt, making the coverage retroactively effective to the exam date.
5
Conclude the final claim action.
The insurer pays the death benefit.
Because coverage was legally in effect at the time of death, the claim is valid despite the lack of policy delivery.

Key Concept

Conditional Insurability Receipts and Retroactive Coverage
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Topics

Initial Premium and Premium Receipts

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